Breast Reduction - Mammaplasty
WOMEN WITH LARGE BREASTS EXPERIENCE MORE THAN DISSATISFACTION WITH BODY IMAGE - they may experience physical pain and discomfort. Overly large breasts and the weight of excess breast tissue can cause pain and physical conditions. that impair a woman's ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.
If you have large breasts that limit your physical activity and cause pain, breast reduction may be right for you. Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with a woman's body and to alleviate the discomfort associated with overly large breasts. In general, breast reduction surgery will not only correct the functional symptoms associated with large breasts, but will also result in better proportioned breasts, enhancing a woman's body image and self-confidence.
Breast reduction is a surgical procedure to reduce the size of large pendulous breasts that are disproportionate to a woman's body and can cause physical pain. Technically called reduction mammaplasty, breast reduction improves breast size, shape and the associated conditions of large breasts that include:
- Back, neck and shoulder pain caused by the weight of excess breast tissue
- Shoulder discomfort and indentation from bra straps that support heavy, pendulous breasts • Restricted physical activity due to breast size and the associated discomfort
- Skin irritation beneath the breast crease
- Sagging, stretched skin and a low breast profile where, when unsupported, the nipple rests below the breast crease
- An enlarged areola (the dark skin surrounding the nipple) caused by stretched skin
Breast reduction can be performed unilaterally (on one breast) or bilaterally (on both breasts). It is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve medical symptoms. Many insurers define breast reduction surgery as reconstructive based on the amount of tissue that will be removed. However, pre-certification is often required for reimbursement or coverage.
Breast reduction surgery can be performed at any age; however it is best performed when the breasts are fully developed. Because significant amounts of breast tissue are removed, breast reduction surgery may impair the ability to breast feed. Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations.
In general, good candidates for breast reduction are women of relatively normal, stable weight whose breast development is complete. Breast reduction is best performed on:
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Individuals with a positive outlook and specific goals in mind for improving their physical symptoms, breast size and shape
A consultation with your plastic surgeon is the first step to learn how a breast reduction can improve the appearance of your breasts and relieve pain, discomfort and any associated symptoms you may have resulting from large, pendulous breasts. A consultation is designed to fully educate you about breast reduction in a non-pressured environment, and will include:
- A discussion of your goals and an evaluation of your individual case
- The options available in breast reduction surgery
- The likely outcomes of breast reduction and any risks or potential complications
- The prescribed course of treatment recommended by your plastic surgeon
Your plastic surgeon will also answer your questions.
Overall health and personal outlook can greatly impact the outcome of breast reduction surgery. These will be carefully evaluated in consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you:
- Honestly share your expectations
- Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
- Be candid about any history of breast cancer in your family and your personal breast health • Commit to precisely following all of your plastic surgeon's instructions
About the Procedure
Breast reduction is more commonly performed through incisions with surgical removal of the excess fat, glandular tissue and skin that contribute to large, pendulous breasts. The most common approach is a keyhole incision pattern.
The nipple, which remains tethered to its original blood and nerve supply, is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. The vertical incisions are brought together to reshape the now smaller breast. Non-removable sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin.
There are alternative incision patterns that may be recommended depending on the amount of tissue and skin to be removed and the quality of skin elasticity. One is a circular pattern around the areola. Another is a racquet-shaped pattern with an incision around the areola and vertically down to the breast crease. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast. In any case, the incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.
In some cases, excess fat may be removed through liposuction in conjunction with excision techniques. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used for breast reduction. In every case, the technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, and patient and surgeon preference.
Breast reduction reduces the size and improves the shape and position of overly large; pendulous breasts through the surgical removal of excess breast fat, tissue and skin.
It may also reposition the areolas (pigmented skin surrounding the nipples) and nipples, and reduce the size of enlarged are olas that may result from stretching of the skin over time.
Breast reduction sometimes is performed by removal of excess fat using liposuction techniques; by surgical removal of excess
glandular tissue, fat, and skin; or by a combination of these techniques.
One of the common surgical technique uses an incision pattern that begin around the areola, continues vertically down the breast and then horizontally along the crease underneath the breast.
Following excision, the nipple is repositioned and the areolar reduced, if necessary. Underlying breast tissue is reduced, lifted and shaped. Sutures, skin adhesives and/or surgical tape close the surface incisions. Most incision lines are concealed in the natural breast contours; however, some are visible on the breast surface.
Although permanent, incision lines are scars that usually fade and improve in appearance over time.
Prepare for Surgery
Your plastic surgeon will carefully explain your breast reduction procedure. Prior to surgery, you will be given specific instructions that may include:
- Pro-surgical considerations, diagnostic testing and medications
- Day of surgery instructions and medications
- Specific information related to the use of anesthesia
- Postoperative care and follow-up
In addition, you will be asked to sign consent forms indicating that you fully understand the procedure you will undergo and the risks or potential complications.
Risks of breast reduction include blood pooling beneath the skin (hematoma), blood clots, infection, and poor healing at the incision site. Changes in nipple or breast sensation are usually temporary. Smokers are at increased risk for poor wound healing particularly at the nipple and areola, and are advised to stop smoking for several weeks before and after surgery. All surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.
It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.
Following Surgery and What to Expect
Breast reduction may be performed in your plastic surgeon's office-based surgical facility, an ambulatory surgical facility or a hospital. The type of anesthesia will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
Once your procedure is complete, dressing or bandages will be applied to your incisions. An elastic bandage or support bra should be worn to minimize swelling and support the breasts as they heal. A small, thin tube may be temporarily placed under the skin to drain any excess blood that may collect. Before being released, you and an accompanying family member, friend or caregiver will be given specific instructions that may include:
- How to care for the surgical site
- Medications to apply or take orally to aid healing and reduce the potential for infection • Specific concerns to look for at the surgical site or in overall health
- When to follow-up with your plastic surgeon
Progress and Healing
Initial healing will include swelling and discomfort at the incision sites. Discomfort is common and can be controlled with medication. A support bra may be recommended around the clock for the first few weeks. It is important to keep the incision sites clean. You will be instructed to engage in light walking as soon as possible to minimize the potential for blood clots and other complications.
Follow all instructions carefully; this is essential to the success of your outcome. A return to light activity is possible as soon as you feel ready, usually within a few days of surgery.
Any sutures will be removed within 10 days following surgery. You may be ready to return to work and more normal activity at this time, as long as you do not engage in any heavy lifting or vigorous exercise.
Healing will continue for several weeks as swelling dissipates and breast shape and position settle. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
Results and Outlook
The final results of breast reduction will appear over the next few months as breast shape and position continue to settle. Incision lines are permanent scars, but they will improve over time and can be hidden under most swimsuits.
Your new breast size should free you from the pain and physical limitations experienced prior to breast reduction. Your better proportioned figure will likely enhance your self-image and boost your self-confidence. Breast reduction is considered permanent although, over time, your breasts may continue to change due to weight fluctuations, aging and gravity.